State Seeks Massive Overhaul Of MassHealth

The Massachusetts Executive Office of Health and Human Services (EOHHS) has released the state’s Medicaid waiver proposal – the document that lays out the state’s plans for operating the state’s Medicaid program (MassHealth) and related healthcare initiatives.  EOHHS is seeking public comment on the proposal through July 15 before submitting it formally to CMS.

Section 1115 of the Social Security Act allows the federal government to waive certain aspects of the Medicaid program to allow states the flexibility to devise programs for certain populations or to allow a state to use federal Medicaid funds in ways that are not otherwise allowed under federal rules.

The main aspect of the state’s waiver proposal is to shift the basic structure of MassHealth from a fee-for-service program (where providers are paid for each individual service) to an accountable care model (where services and payments throughout the full spectrum of care are bundled). To do this, EOHHS’ Office of Medicaid proposes offering providers three Accountable Care Organization models that are each tied in some form to MassHealth’s managed care organizations.

Another key component of the state’s waiver involves restructuring the state’s Safety Net Care Pool.  Massachusetts needs CMS to sign off on the proposed waiver because the federal authorization for the current Safety Net Care Pool – as well as other healthcare programs – expires on June 30, 2017. “If Massachusetts does not reach an agreement to restructure the Safety Net Care Pool prior to the end of June 2017, it will lose federal authorization for over a billion dollars in expenditures each year,” EOHHS notes in the waiver proposal.

Behavioral healthcare – generally recognized as the portion of the Massachusetts system most in need of repair – is a major focus of the waiver. EOHHS writes that “an explicit goal of this waiver demonstration is the integration of physical health and behavioral health for individuals with a range of behavioral health needs.” To do so, the state offers a variety of approaches, including “the role of certified Behavioral Health Community Partners; contractual expectations for managed care plans, the Massachusetts Behavioral Health Partnership, and ACOs; and other payment model adjustments.” Massachusetts also will encourage ACOs to integrate behavioral health and long-term services and supports community partners into care teams.

As it refines its proposal, the state will hold two public listening sessions: Session #1 will be on Friday, June 24, from 2:30 to 4 p.m. at 1 Ashburton Place, 21st Floor, Boston; conference Line: 1-866-565-6580, Passcode: 9593452.  Session #2 is set for Monday, June 27, from 2 to 3:30 p.m. at Fitchburg Public Library, 610 Main Street, Fitchburg.

MHA is reviewing the document along with its membership and has been in contact with EOHHS throughout the process.

The state’s 92-page Section 1115 Demonstration Project Amendment and Extension Request is below.